148 Part IV / Mechanical Complications
gical techniques. Other small series report operative survival ranging from 40% to
100% (45,49,52).
CONCLUSION
In summary, the diagnosis of a postinfarction mechanical complication is a surgical
emergency. The diagnosis is established with echocardiography. For ventricular septal
and papillary muscle ruptures, a preoperative coronary angiogram is preferable if pos-
sible. Inotropes and intra-aortic balloon counterpulsation are helpful in providing tem-
porary hemodynamic stabilization while the patient is being prepared for transfer to the
operating room. Intraoperative transesophageal echocardiography should be used rou-
tinely. IABP counterpulsation is an important adjunct in the early postoperative period
to decrease left ventricular wall tension and thus decrease stress on the repair.
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